Heart disease is not just a man's disease. In fact, 1 in 4 women in the
United States dies from heart disease. CHD, the most common type of heart
disease, affects both women and men.

CHD is a condition in which plaque builds up on the inner walls of the coronary
arteries. Plaque is made up of fat, cholesterol,
calcium, and other substances found in the blood.

Plaque can affect the heart in two ways:

The buildup of plaque can narrow the coronary arteries over time.
This reduces blood flow to the heart muscle and can lead to symptoms
such as angina. Angina is chest pain
or discomfort.

Plaque can suddenly rupture or crack, causing a blood clot to form
on the plaque's surface. The blood clot rapidly blocks blood flow within
the artery. If the clot becomes large enough, it can completely block
blood flow to part of the heart muscle. This is the most common cause
of a heart attack.

Heart with muscle damage and a blocked artery.
Figure A: overview of a heart and coronary artery showing damage (dead
heart muscle) caused by a heart attack. Figure B: cross-section of
the coronary artery with plaque buildup and a blood clot resulting
from plaque rupture

In women and men who have CHD, plaque usually builds up inside the heart's
large arteries, causing them to narrow. Plaque also can develop within the
walls of these arteries. In people who have this pattern of plaque, tests
that outline the coronary arteries may look normal. Studies are under way
to see whether this type of plaque buildup occurs more often in women than
in men and why.

What can differ between women and men is a disease called coronary
microvascular disease (MVD). Coronary MVD is heart disease that affects
the heart's smallest arteries. Recently, studies have shown that women are
more likely than men to have coronary MVD.

Coronary microvascular disease.
Figure A: the small coronary artery network (microvasculature), containing
a normal artery and an artery with coronary MVD. Figure B: a large
coronary artery with plaque buildup

Many researchers think that a drop in estrogen
levels in women during menopause combined with traditional risk factors
for heart disease causes coronary MVD.

Although death rates from heart disease have dropped in the last 30 years,
they haven't improved as much in women as in men. This may be the result
of coronary MVD. Standard tests for CHD don't always detect coronary MVD
in women. As a result, women often are thought to be at low risk for heart
disease.

Research is ongoing to learn more about coronary MVD and its causes.

Women also are more likely than men to develop a condition called broken
heart syndrome. In this recently recognized heart problem, extreme emotional
stress can lead to reversible heart muscle failure.

Doctors may misdiagnose broken heart syndrome as a heart attack because
it has similar symptoms. However, there's no evidence of blocked heart arteries
in broken heart syndrome, and most people have a full and quick recovery.
Researchers are just beginning to explore what causes this disorder and
how to diagnose and treat it. Often, patients who have broken heart syndrome
have been previously healthy.

This article focuses on CHD, unless otherwise noted.

Outlook

Women tend to develop CHD about 10 years later than men. However, CHD remains
the #1 killer of women in the United States.

Women are more likely to die following a heart attack than men. This is
in part due to being older and having other significant health problems
at the time a heart attack occurs.

The good news is that steps can be taken to control many CHD risk factors.
Risk factors are conditions or habits that raise the risk of CHD and heart
attack. Uncontrolled risk factors also can increase the chance that existing
CHD will worsen.

Lifestyle changes, medicines, and/or medical or surgical procedures can
help women reduce their risk of CHD. That's why early and ongoing CHD prevention
is so important.

Causes of heart disease

Research suggests that coronary heart disease (CHD) starts when certain
factors damage the lining and inner layers of the coronary arteries. These
factors include:

When damage occurs, the body starts a healing process. The healing may cause
plaque to build up where the arteries are damaged.

The buildup of plaque in the coronary arteries may start in childhood. Over
time, as plaque continues to build up, it can narrow or completely block
some of your coronary arteries. This reduces the flow of oxygen-rich blood
to the heart muscle.

Plaque also can suddenly rupture. This causes blood cell fragments called
platelets to clump together with substances in the blood to form blood clots
to seal the cracks. The blood clots narrow the arteries and may suddenly
worsen angina. If a clot is big enough to block a coronary artery, it can
cause a heart attack.

In addition to the factors above, low estrogen levels occurring before or
after menopause may play a role in coronary microvascular disease (MVD).
Coronary MVD is heart disease that affects the heart's smallest arteries.

The cause of broken heart syndrome isn't yet known. However, stress hormones
and sex hormones, such as estrogen, may play a role in causing the syndrome.

Who is at risk for heart disease?

Certain traits, conditions, or habits may raise the risk of coronary heart
disease. These conditions are known as risk factors. Risk factors also increase
the chance that existing CHD will worsen.

Women have the same CHD risk factors as men. However, some risk factors
may affect CHD risk differently in women than in men. For example, diabetes
raises the risk of CHD more in women. Also, other factors, such as birth
control pills and menopause, may affect women's risk of CHD.

There are a number of known CHD risk factors. The risk of CHD and heart
attack increases with the number of risk factors a person has and their
severity. Risk factors tend to "gang up" and worsen each other's effects.

Having just one risk factor doubles the risk of CHD. Having two risk factors
increases your the of CHD fourfold. Having three or more risk factors increases
the risk of CHD more than tenfold.

Also, some risk factors, such as smoking and diabetes, put an individual
at greater risk of CHD and heart attack than others.

More than three-quarters of women aged 40 to 60 have one or more risk factors
for CHD. Many risk factors start during childhood; some even develop within
the first 10 years of life. Most risk factors can be controlled, but some
can't.

Risk factors that can be controlled

Smoking

Smoking is the most powerful risk factor that women can control. Smoking
tobacco or long-term exposure to secondhand smoke raises the risk of CHD
and heart attack.

Smoking exposes a person to carbon monoxide. This chemical robs the blood
of its needed oxygen and triggers a buildup of plaque in the arteries.

Smoking also increases the risk of blood clots forming in the arteries.
Blood clots can block plaque-narrowed arteries and cause a heart attack.
The more a person smokes, the greater her risk of a heart attack. Even women
who smoke fewer than two cigarettes a day are at increased risk of CHD.

High blood cholesterol and high triglyceride levels

Cholesterol travels in the bloodstream in small packages called lipoproteins.
The two major kinds of lipoproteins are low-density lipoprotein (LDL) cholesterol
and high-density lipoprotein (HDL) cholesterol.

LDL cholesterol is sometimes called "bad" cholesterol. This is because it
carries cholesterol to tissues, including the heart arteries. HDL cholesterol
is sometimes called "good" cholesterol. This is because it helps remove
cholesterol from the arteries.

A blood test called a lipoprotein profile is used to measure cholesterol
levels. This test gives information about the total cholesterol, LDL cholesterol,
HDL cholesterol, and triglycerides (a type of fat found in the blood).

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter
(dL) of blood. A total cholesterol level greater than 200 mg/dL, an LDL
cholesterol level greater than 100 mg/dL, or an HDL cholesterol level less
than 50 mg/dL increases a woman's risk of CHD.

A triglyceride level greater than 150 mg/dL also increases a woman's risk
of CHD. A woman's HDL cholesterol and triglyceride level predict her risk
of CHD better than her total cholesterol or LDL cholesterol level.

High blood pressure

Women who have blood pressure greater than 120/80 mmHg are at increased
risk of CHD. (The mmHg is millimeters of mercury – the units used
to measure blood pressure.)

Blood pressure should be even lower in women who have kidney disease or
diabetes. If a women has one of these diseases, she should talk to her doctor
about a healthy blood pressure measurement.

Diabetes and
prediabetes

Diabetes is a disease in which the body's blood sugar level is high because
the body doesn't make enough insulin or doesn't use its insulin properly.
Over time, a high blood sugar level can contribute to increased plaque buildup
in the arteries.

Prediabetes is a condition in which the blood sugar level is higher than
normal, but not as high as it is in diabetes. Prediabetes puts a person
at higher risk for both diabetes and CHD.

Diabetes and prediabetes raise the risk of CHD more in women than in men.
Diabetes doubles women's risk of CHD and counters the protective effect
of estrogen in premenopausal women.

Overweight and obesity

The terms "overweight" and "obesity" refer to a person's overall body weight
and whether it's too high. Overweight is having extra body weight from muscle,
bone, fat, and/or water. Obesity is having a high amount of extra body fat.

The most commonly used measure of overweight and obesity is body mass index
(BMI). BMI is calculated from your height and weight. In adults, a BMI of
18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight.
A BMI of 30 or above is considered obese.

Studies suggest that where extra weight occurs on the body may more accurately
predict CHD risk than BMI. Women who carry much of their fat around the
waist are at greatest risk of CHD. These women have "apple-shaped" figures.

Women who carry most of their fat on their hips and thighs – that
is, those who have "pear-shaped" figures – are at lower risk of CHD
than women who are apple shaped.

To fully know how excess weight affects your CHD risk, it's important to
know your BMI and waist measurement. If you have a BMI greater than 24.9
and a waist measurement greater than 35 inches, you're at increased risk
of CHD. If your waist measurement divided by your hip measurement is greater
than 0.9, you're also at increased risk of CHD.

Studies also suggest that women whose weight goes up and down dramatically
(typically due to unhealthy dieting) are at increased risk of CHD. These
swings in weight can lower HDL cholesterol levels.

Metabolic
syndrome

Metabolic
syndrome is the name for a group of risk factors linked to overweight
and obesity that increase your risk of CHD. A diagnosis of metabolic syndrome
is made if a person has at least three of the following risk factors:

Metabolic syndrome is more common in African American women than in African
American men and in Mexican American women than in Mexican American men.
The condition affects White women and men about equally.

Birth control pills

Women who smoke and take birth control pills are at very high risk of CHD,
especially if they're older than 35. The risks of birth control pills in
women who don't smoke aren't fully known.

Lack of physical
activity

Inactive people are nearly twice as likely to develop CHD as those who are
physically active. A lack of physical activity can worsen other CHD risk
factors, such as high blood cholesterol and triglyceride levels, high blood
pressure, diabetes and prediabetes, and overweight and obesity.

Unhealthy diet

An unhealthy diet can raise the risk of CHD. For example, foods that are
high in saturated and trans fats and cholesterol raise LDL cholesterol.
Thus, intake of these foods shoule be limited.

Saturated fats are found in some meats, dairy products, chocolate, baked
goods, oils of animal origin, and palm and coconut oils. Deep-fried and
processed foods often contain saturated fats.

Trans fats are found in some fried and processed foods. Cholesterol is found
in eggs, many meats, dairy products, commercial baked goods, and certain
types of shellfish.

It's also important to limit foods that are high in sodium (salt) and simple
sugars. A high-salt diet can raise the risk of high blood pressure. Added
simple sugars will give you extra calories without nutrients like vitamins
and minerals. This can cause you to gain weight, which raises the CHD risk.
Added sugars are found in many desserts, candies, canned fruits packed in
syrup, fruit drinks, and nondiet sodas.

You also should try to limit how much alcohol you drink. Too much alcohol
will raise your blood pressure. It also will add calories, which can cause
weight gain.

Women should have no more than one alcoholic drink a day. If you're pregnant,
if you're planning to become pregnant, or if you have another health condition
that could make alcohol use harmful, you shouldn't drink.

Stress or depression

Stress may contribute to the development of CHD. Stress can trigger the
arteries to narrow. This can raise the blood pressure and the risk of a
heart attack.

A commonly reported trigger for a heart attack is an emotionally upsetting
event, especially one involving anger. Stress also may indirectly raise
your risk of CHD if it makes you more likely to smoke or overeat foods high
in fat and sugar.

People who have depression are two to three times more likely to develop
CHD than people who don't. Depression is twice as common in women as in
men.

Anemia

Anemia
is a condition in which your blood has a lower than normal number of red
blood cells. The condition also can occur if the red blood cells don't contain
enough hemoglobin. Hemoglobin is an iron-rich
protein that helps red blood cells carry oxygen from the lungs to the rest
of the organs.

If you have anemia, your organs don't get enough oxygen-rich blood. This
causes your heart to work harder, which may raise your risk of CHD and coronary
microvascular disease.

Sleep apnea

Sleep
apnea is a common disorder in which you have pauses in breathing or
shallow breaths while you sleep. Breathing pauses can last from a few seconds
to minutes. They often occur 5 to 30 times or more an hour. Typically, normal
breathing then starts again, sometimes with a loud snort or choking sound.

When you stop breathing, the lack of oxygen triggers your body's stress
hormones. This causes blood pressure to rise and makes the blood more likely
to clot.

Major signs of sleep apnea are snoring and daytime fatigue (tiredness).
Untreated sleep apnea can raise your chances of having high blood pressure,
diabetes, and even a heart attack or stroke.

Women are more likely to develop sleep apnea after menopause.

Risk factors that can't be controlled

Age
and menopause

As you get older, your risk of CHD and heart attack rises. This is in part
due to the slow buildup of plaque inside your heart arteries, which can
start during childhood.

Before age 55, women have a lower risk of CHD than men. After age 55, however,
the risk of CHD increases in both women and men. This is in part because
before menopause, estrogen provides women with some protection against CHD.

You may have gone through early menopause, either naturally or because you
had your ovaries removed. If so, you're twice as likely to develop CHD as
women of the same age who aren't yet menopausal.

Another reason why women are at increased risk of CHD after age 55 is that
middle age is when you tend to develop other CHD risk factors.
Being postmenopausal also increases your risk of broken heart syndrome.

Family history

Family history plays a role in CHD risk. Your risk increases if your father
or brother was diagnosed with CHD before 55 years of age, or if your mother
or sister was diagnosed with CHD before 65 years of age.

However, having a family history of CHD doesn't mean that you'll have CHD
too. This is especially true if your affected family member smoked or had
other CHD risk factors that were not well treated.

Making lifestyle changes and taking medicines to treat risk factors often
can lessen genetic influences and stop or slow the progress of CHD.

Preeclampsia

Preeclampsia is a condition that develops during pregnancy. The two main
signs of preeclampsia are a rise in blood pressure and excess protein in
the urine. These signs usually occur during the second half of pregnancy
and go away after delivery. However, your risk of developing high blood
pressure later in life increases after having preeclampsia.

Preeclampsia is linked to an increased lifetime risk of heart disease, including
coronary heart disease, heart attack, heart failure, and high blood pressure.
(Likewise, having heart disease risk factors, such as diabetes or obesity,
increases your risk of preeclampsia.)

If you had preeclampsia, you're twice as likely to develop heart disease
as women who didn't have the condition during pregnancy. You're also more
likely to develop heart disease earlier in life.

Preeclampsia is a heart disease risk factor that you can't control. However,
if you've had the condition, you should take extra care to try and control
the heart disease risk factors that you can.

The more severe your preeclampsia was, the greater your risk of heart disease.
Let your doctor know that you had preeclampsia so he or she can better assess
your heart disease risk and how to reduce it.

Emerging
risk factors

Some research suggests that the body's response to injury or infection (inflammation)
plays a role in causing CHD. Damage to the arteries' inner walls seems to
trigger inflammation and help plaque grow.

High blood levels of a protein called C-reactive protein (CRP) are a sign
of inflammation in the body. Research is ongoing to see whether CRP or other
signs of inflammation can predict CHD risk in women.

Some studies suggest that women who have migraine headaches may be at greater
risk of CHD. This is especially true for women who have migraines that are
accompanied by auras (visual disturbances), such as flashes of light or
zig-zag lines.

Researchers are just starting to learn which factors increase the risk of
broken heart syndrome. Most women who develop this disorder are White and
postmenopausal.

Many of these women have other heart disease risk factors, such as high
blood pressure, high blood cholesterol, diabetes, and smoking. However,
these risk factors tend to be less common in women who have broken heart
syndrome than in women who have CHD.

Signs and symptoms of heart disease

The signs and symptoms of coronary heart disease (CHD) may differ between
women and men. Some women who have CHD have no signs or symptoms. This is
called silent CHD.

Silent CHD may not be diagnosed until a woman shows signs and symptoms of
a heart attack, heart failure, or an arrhythmia (irregular heartbeat).

Major signs and symptoms of coronary
heart disease

A common symptom of CHD is angina. Angina is chest pain or discomfort that
occurs when your heart muscle doesn't get enough oxygen-rich blood.

In men, angina often feels like pressure or a squeezing pain in the chest.
This feeling may extend to the arms. Women also can have these angina symptoms.
But women also tend to describe a sharp, burning chest pain. Women also
are more likely to have pain in the neck, jaw, throat, abdomen, or back.

In men, angina tends to get worse with physical activity and go away with
rest. Women are more likely than men to have angina while they're resting
or sleeping.

In women who have coronary microvascular disease, angina often occurs during
routine daily activities, such as shopping or cooking, rather than while
exercising. Mental stress also is more likely to trigger angina pain in
women than in men.

The severity of angina varies. The pain may get worse or occur more often
as the buildup of plaque continues to narrow the coronary (heart) arteries.

Signs and symptoms of heart problems linked to coronary
heart disease

Heart attack

The most common symptom of heart attack in men and women is chest pain or
discomfort. However, only half of women who have heart attacks have chest
pain.

Women are more likely to report back or neck pain, indigestion, heartburn,
nausea (feeling sick to the stomach), vomiting, extreme fatigue (tiredness),
or problems breathing.

Heart attacks also can cause upper body discomfort in one or both arms,
the jaw, or the stomach. Other symptoms of heart attack are lightheadedness
and fainting, which occur more often in women than men.

Men who are having a heart attack are more likely to break out in a cold
sweat and to report pain in their left arms than women.

Heart
failure

Heart failure is a condition in which your heart weakens and can't pump
enough blood throughout your body. Heart failure doesn't mean that your
heart has stopped or is about to stop working. It means that your heart
can't cope with the demands of everyday activities.

Heart failure causes shortness of breath and fatigue that tends to increase
with activity. Heart failure also can cause swelling in your feet, ankles,
legs, and abdomen.

Arrhythmia

An arrhythmia is a problem with the rate or rhythm of your heartbeat. During
an arrhythmia, the heart can beat too fast, too slow, or with an irregular
rhythm.

Some people describe arrhythmias as fluttering or thumping feelings or skipped
beats in their chests. These feelings are called palpitations.

Some arrhythmias can cause your heart to suddenly stop beating. This condition
is called sudden cardiac arrest (SCA). SCA causes loss of consciousness
and death if it's not treated right away.

Signs and symptoms
of broken heart syndrome

The most common signs and symptoms of broken heart syndrome are chest pain
and shortness of breath. In this syndrome, these symptoms tend to occur
suddenly in people who have no history of heart disease.

Arrhythmias or cardiogenic shock also may occur. Cardiogenic shock is a
state in which a weakened heart isn't able to pump enough blood to meet
the body's needs.

Broken heart syndrome has several signs and symptoms that distinguish it
from a heart attack:

Symptoms occur suddenly after having extreme emotional or physical
stress.

The EKG (electrocardiogram) results for a person who has broken heart
syndrome don't look the same as the EKG results for a person having
a heart attack. (An EKG is a test that records the heart's electrical
activity.)

Blood tests show no signs or mild signs of heart damage.

Tests show no signs of blockages in the coronary arteries.

Tests show unusual movement of the lower left heart chamber (left
ventricle).

Recovery time is quick, usually within days to weeks (compared to
the recovery time of a month or more for a heart attack).

Diagnosis of heart disease

Your doctor will diagnose coronary heart disease (CHD) based on your medical
and family histories, your risk factors, a physical exam, and the results
from tests and procedures.

No single test can diagnose CHD. If your doctor thinks you have CHD, he
or she may recommend one or more of the following tests.

EKG (electrocardiogram)

An EKG is a simple, painless test
that detects and records the heart's electrical activity. The test shows
how fast the heart is beating and its rhythm (steady or irregular). An EKG
also records the strength and timing of electrical signals as they pass
through each part of the heart.

Certain electrical patterns that the EKG detects can suggest whether CHD
is likely or whether the heart muscle is abnormally thickened. An EKG also
can show signs of a previous or current heart attack.

Stress
testing

During stress testing, you exercise
(or are given medicine if you're unable to exercise) to make your heart
work hard and beat fast while heart tests are done.

Some stress tests take pictures of your heart when you're at rest and when
you exercise. These imaging stress tests can show how well blood is flowing
in various parts of your heart and/or how well your heart pumps blood when
it beats.

Echocardiography

Echocardiography (echo) uses sound
waves to create a moving picture of your heart. The test provides information
about the size and shape of your heart and how well your heart chambers
and valves are working.

Echo also can identify areas of poor blood flow to the heart, areas of heart
muscle that aren't contracting normally, and previous injury to the heart
muscle caused by lack of blood flow.

Chest X-ray

A chest X-ray takes pictures of the
organs and structures inside your chest, such as your heart, lungs, and
blood vessels. A chest X-ray can reveal signs of heart failure, as well
as lung disorders and other causes of symptoms that aren't due to CHD.

Blood tests

Blood tests can detect disorders such
as anemia and check the levels of certain fats, cholesterol, sugar, and
proteins in your blood. Abnormal levels of these substances may show that
you have risk factors for CHD.

During a heart attack, heart muscle cells die. When they die, they release
certain proteins into the bloodstream. Blood tests can measure the amount
of these proteins in the bloodstream. Higher than normal levels of these
proteins in the bloodstream is evidence of a recent heart attack.

Electron-beam computed tomography

Your doctor may recommend electron-beam computed tomography (EBCT). This
test finds and measures calcium deposits (called calcifications) in and
around the heart arteries. The more calcium detected, the more likely you
are to have CHD.

EBCT isn't used routinely to diagnose CHD because its accuracy isn't yet
known.

Coronary angiography and cardiac catheterization

Your doctor may recommend coronary
angiography if other tests or factors show that you likely have CHD.
This test uses dye (contrast material) and special X-rays to show the insides
of your coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure
called cardiac catheterization.
A long, thin, flexible tube called a catheter will be put into a blood vessel
in your groin (upper thigh), arm, or neck.

Your doctor will thread the tube into your coronary arteries, and the dye
will be released into your bloodstream. Special X=rays will be taken while
the dye is flowing through your coronary arteries. These X-rays are called
angiograms.

Coronary angiography detects blockages in the large coronary arteries. However,
the test doesn't detect coronary microvascular disease (MVD). This is because
coronary MVD doesn't cause blockages in the large coronary arteries. If
the results of your coronary angiography are normal, but you still have
chest pain or other CHD symptoms, talk to your doctor about whether you
might have coronary MVD.

Your doctor may ask you to fill out a questionnaire called the Duke Activity
Status Index. This questionnaire measures how easily you can do routine
tasks. It gives your doctor information about how well blood is flowing
through your coronary arteries.

Other tests that measure blood flow in the heart also can detect coronary
MVD. These tests include a cardiac MRI (magnetic resonance imaging) stress
test and a test done during cardiac catheterization that shows blood flow
in the heart's small arteries.

Tests used to diagnose
broken heart syndrome

If your doctor thinks you have broken heart syndrome, he or she may recommend
coronary angiography. Other tests also are used to diagnose this disorder,
including blood tests, EKG, echocardiography, and cardiac
MRI.

Cardiac MRI uses radio waves, magnets, and a computer to created pictures
of your heart as it's beating. The test produces both still and moving pictures
of your heart and major blood vessels.

Treatment of heart disease

Treatment for coronary heart disease (CHD) usually is the same for both
women and men. Treatment may include lifestyle changes, medicines, medical
and surgical procedures, and cardiac rehabilitation (rehab).

The goals of treatments include:

Relieving symptoms.

Reducing CHD risk factors in an effort to slow, stop, or reverse the
buildup of plaque.

Lifestyle changes

Making lifestyle changes often can help prevent or treat CHD. Lifestyle
changes may include following a heart healthy diet, doing physical activity
regularly, maintaining a healthy weight, quitting smoking, and managing
stress and depression.

Following a heart healthy diet

A heart healthy diet is an important part of a healthy lifestyle. To lower
your risk of CHD, follow a diet:

That's low in saturated and trans fats. Saturated fats are found in
some meats, dairy products, chocolate, baked goods, oils of animal origin,
and palm and coconut oils. Deep-fried and processed foods often have
saturated fats. Trans fats are found in some fried and processed foods.
Both types of fat raise your LDL cholesterol level.

That includes the types of fat found in fish and olive oil. These
fats are rich in omega-3 fatty acids. Omega-3 fatty acids lower your
risk of heart attack, in part by helping prevent blood clots.

That's high in fiber, whole grains, fruits, and vegetables. A diet
that's rich in these elements not only helps lower your LDL cholesterol
level, but also provides nutrients that may help protect against CHD.

That's low in salt and sugar. A low-salt diet can help you manage
your blood pressure. A low-sugar diet can help you prevent weight gain
and control diabetes and prediabetes.

Research suggests that drinking small to moderate amounts of alcohol regularly
also can lower your risk of CHD. Women should have no more than one alcoholic
drink a day. One drink a day can lower your CHD risk by raising your HDL
cholesterol level. One drink is a glass of wine, beer, or a small amount
of hard liquor.

If you don't drink, this isn't a recommendation to start using alcohol.
If you're pregnant, if you're planning to become pregnant, or if you have
another health condition that could make alcohol use harmful, you shouldn't
drink.

Also, too much alcohol can cause you to gain weight and raise your blood
pressure and triglyceride level. In women, even one drink a day may raise
the risk of certain types of cancer.

Doing physical activity
regularly

Regular physical activity can lower many CHD risk factors, including high
LDL cholesterol, high blood pressure, and excess weight.

Talk to your doctor before you start a new exercise plan. Ask him or her
how much and what kinds of physical activity are safe for you.

People gain some health benefits from as little as 60 minutes of moderate-intensity
aerobic activity per week. Walking is an excellent heart healthy exercise.
The more active you are, the more you will benefit.

Maintaining
a healthy weight

Following a healthy diet and being physically active can help you maintain
a healthy weight. Controlling your weight helps you control CHD risk factors.

If you're overweight or obese, aim to reduce your weight by 5 to 10 percent
during your first year of treatment. This amount of weight loss can lower
your risk of CHD and other health problems. Your health care provider may
refer you to a dietitian to help you manage your weight.

After the first year, you may have to continue to lose weight. A BMI of
less than 25 and a waist circumference of 35 inches or less is the goal
for preventing and treating CHD.

To measure your waist, stand and place a tape measure around your middle,
just above your hipbones. Measure your waist just after you breathe out.
Make sure the tape is snug but doesn't squeeze the flesh.

Quitting smoking

If you smoke or use tobacco, try to quit. Smoking can damage and constrict
(tighten) blood vessels. It also can raise your risk of CHD and heart attack
and worsen other CHD risk factors. Talk to your doctor about programs and
products that can help you quit. Also, try to avoid secondhand smoke.

Managing stress and depression

Research shows that a common "trigger" for a heart attack is an emotionally
upsetting event梡articularly one involving anger. Also, some of the ways
people cope with stress, such as drinking, smoking, or overeating, aren't
heart healthy.

Learning how to manage stress, relax, and cope with problems can improve
your emotional and physical health.

Having supportive people in your life with whom you can share your feelings
or concerns can help relieve stress. Physical activity, yoga, and relaxation
therapy also can help relieve stress. You may want to consider participating
in a stress management program.

Depression doubles or triples you risk of CHD. Depression also makes it
hard to maintain a heart healthy lifestyle.

Talk to your doctor if you have symptoms of depression, such as feeling
hopeless or not taking interest in daily activities. He or she may recommend
counseling or prescribe medicines to help you manage the condition.

Medicines

If lifestyle changes aren't enough, you also may need medicines to prevent
or treat CHD. Medicines can:

Take all of your medicines as prescribed. If you have side effects or other
problems related to your medicines, talk to your doctor. He or she may be
able to provide other options.

Menopausal hormone therapy

Recent studies have shown that menopausal hormone therapy (MHT) doesn't
prevent CHD. Some studies have even shown that MHT increases women's risk
of CHD, stroke, and breast cancer. However, these studies tested MHT on
women who had been postmenopausal for at least several years. During that
time, they could have already developed CHD.

Research is ongoing to see whether MHT helps prevent CHD when taken right
when menopause starts. While questions remain, current findings suggest
MHT shouldn't be used routinely to prevent or treat CHD.

Talk with your doctor about other ways to prevent or treat CHD, including
lifestyle changes and medicines.

Medical and surgical
procedures

You may need a medical or surgical procedure to treat CHD. Both angioplasty
and CABG are used as treatments.

Angioplasty opens blocked or narrowed coronary arteries. A thin, flexible
tube with a balloon or other device on the end is threaded through a blood
vessel to the narrowed or blocked coronary artery.

Once in place, the balloon is inflated to push the plaque outward against
the wall of the artery. This widens the artery and restores the flow of
blood.

Angioplasty can improve blood flow to your heart, relieve chest pain, and
possibly prevent a heart attack. Often, a small mesh tube called a stent
is placed in the artery to keep it open as a part of the procedure.

In CABG, a surgeon removes arteries or veins from other areas in your body
and uses them to bypass (that is, go around) narrowed or blocked coronary
arteries. CABG can improve blood flow to your heart, relieve chest pain,
and possibly prevent a heart attack.

Cardiac rehabilitation

Cardiac rehab, when combined with medicine and surgical treatments, can
help you recover faster, feel better, and follow a healthier lifestyle.
Almost everyone who has CHD can benefit from cardiac rehab.

Your cardiac rehab team may include doctors, nurses, exercise specialists,
physical and occupational therapists, dietitians, and psychologists or other
behavioral therapists.

Cardiac rehab has two parts:

Exercise training. This part of rehab helps you learn how to exercise
safely, strengthen your muscles, and improve your stamina. Your exercise
plan will be based on your individual abilities, needs, and interests.

Education, counseling, and training. This part of rehab helps you
understand your heart condition and find ways to reduce your risk of
future heart problems. The cardiac rehab team will help you learn how
to cope with the stress of adjusting to a new lifestyle and with your
fears about the future.

Prevention of heart disease

Your risk of coronary heart disease (CHD) increases with the number of CHD
risk factors you have. Taking action to control your risk factors can help
prevent or delay CHD and its complications.

One step you can take is to adopt a heart healthy lifestyle. A heart healthy
lifestyle should be part of a lifelong approach to healthy living.

Following a healthy diet is an important part of a healthy lifestyle. A
healthy diet includes a variety of fruits, vegetables, and whole grains.
It also includes lean meats, poultry, fish, beans, and fat-free or low-fat
milk or milk products. A healthy diet is low in saturated fat, trans fat,
cholesterol, sodium (salt), and added sugar.

If you're overweight or obese, work with your doctor to create a reasonable
weight-loss plan that involves diet and physical activity. Controlling your
weight helps you control CHD risk factors.

Try to do physical activity regularly. Physical activity can improve your
fitness level and your health. Talk to your doctor about what types of activity
are safe for you.

If you smoke, quit. Smoking can damage and constrict (tighten) blood vessels.
It also can raise your risk of CHD and heart attack and worsen other CHD
risk factors. Talk to your doctor about programs and products that can help
you quit. Also, try to avoid secondhand smoke.

Know your family history of CHD. If you or someone in your family has CHD,
be sure to tell your doctor.

If lifestyle changes aren't enough, you also may need medicines to control
your CHD risk factors. Take all of your medicines as prescribed.

Living with heart block

If you have coronary heart disease (CHD), you should take steps to manage
the condition, reduce CHD risk factors, and prevent complications. You can
do this by making lifestyle changes, getting ongoing care, and knowing the
warning signs of heart problems.

Having CHD raises your risk of a heart attack. If you have signs and symptoms
of a heart attack for more than 5 minutes, you should call 9𢴏. These
signs and symptoms may include chest pain, upper body discomfort, shortness
of breath, and nausea (feeling sick to your stomach).

For more detailed information about the warning signs of heart attack, see
the section on warning signs below.

Lifestyle changes

Adopting a heart healthy lifestyle can help you control CHD risk factors.
However, making lifestyle changes can be a challenge.

Try to take things one step at a time. Learn about the benefits of lifestyle
changes, and make a plan with specific, realistic goals. Reward yourself
for your progress.

The good news is that many lifestyle changes help control several CHD risk
factors at the same time. For example, physical activity lowers your blood
pressure and LDL cholesterol level, helps control diabetes and prediabetes,
reduces stress, and helps control your weight.

Ongoing
care

Your CHD risk factors can change over time, so it's important to get ongoing
care. Your doctor will track your blood pressure, blood cholesterol, and
blood sugar levels with routine tests. These tests will show whether your
treatment needs to be adjusted.

Talk to your doctor about how often you should schedule followup visits
or blood tests. Between visits, call your doctor if you develop any new
symptoms or if your symptoms worsen.

You may feel depressed or anxious if you've been diagnosed with CHD. You
may worry about heart problems or making lifestyle changes that are necessary
for your health.

Your doctor may recommend medicine, professional counseling, or relaxation
therapy if you have depression or anxiety. It's important to treat depression
and anxiety because they raise your risk of CHD and heart attack and make
it harder to carry out lifestyle changes.

Warning signs

It's important to learn the signs and symptoms of a heart attack. Call 9𢴏
if you have any of these symptoms for more than 5 minutes:

Chest pain or discomfort梪ncomfortable pressure, squeezing, fullness,
burning, or pain in the center of the chest that can be mild or strong.
This discomfort or pain lasts more than a few minutes or goes away and
comes back.

Upper body discomfort in one or both arms, the neck, jaw, throat,
abdomen, or back.

Shortness of breath, which may occur with or before chest discomfort.

Nausea, vomiting, lightheadedness or fainting, or breaking out in
a cold sweat.

Early treatment can prevent or limit damage to your heart muscle. If you
think you're having a heart attack, don't drive yourself or have friends/family
drive you to the hospital. Call an ambulance so that medical personnel can
begin life-saving treatment on the way to the emergency room.

If your symptoms last for less than 5 minutes, you should still call your
doctor. Also, let the people you see regularly know you're at risk of a
heart attack. They can seek emergency care if you suddenly faint, collapse,
or develop other severe symptoms.

Living with broken
heart syndrome

Most people who have broken heart syndrome make a full recovery within weeks.
The risk of another episode of broken heart syndrome is low.

To check your heart health, your doctor may recommend echocardiography about
a month after you're diagnosed with the syndrome. Talk with your doctor
about how often you should schedule followup visits.